Identifying Medical Students in Difficulty Using Integration of Programmatic Assessment and Real-Time Evaluation Framework.

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Optimising Preeclampsia First-Trimester Screening Using Three Parameters.

OBJECTIVE: To evaluate the performance of first-trimester preeclampsia-screening algorithm in predicting preeclampsia (PE). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Combined Military Hospitals (CMH) Lahore, Pakistan, between 1st January and 31st August 2022. METHODOLOGY: Data of 100 women of any parity aged 18-35 years at gestational age < 13 weeks based on the last menstrual period (LMP), was analysed. First trimester Fetal Medicine Foundation (FMF) screening algorithm for preeclampsia was used entering maternal characteristics, mean arterial pressure and uterine pulsatility index only, for risk calculation. Patients were followed up till delivery for the development of preeclampsia and fetomaternal outcomes. Clinical characteristics of women with and without preeclampsia were compared using the Chi-square and independent samples t-test. RESULTS: The mean age of patients was 29.29±4.56 years and 60% were nullipara. Seventy-eight patients were placed in the low-risk category and 22 patients were in the high-risk category according to the FMF algorithm. Preeclampsia developed in 13 patients. For a risk cut-off of 1 in 100, the FMF algorithm showed a detection rate of 38% with diagnostic accuracy of 75% and a false positive rate (FPR) of 20%. CONCLUSION: Although the performance of adapted FMF algorithm to predict preeclampsia gestational was low, it was found superior to prediction by maternal risk factors alone. Adjustment for additional factors or ethnicity-specific values may help in further improvement of detection rate. KEY WORDS: Blood pressure, Biomarkers, Biological markers, Preeclampsia, Risk assessment.

A Multi-centre Experience of Trans-abdominal Chorionic Villus Sampling in Pakistan.

OBJECTIVE: To determine the safety and outcomes of trans-abdominal chorionic villus sampling technique. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Departments of Obstetrics and Gynaecology, PNS Shifa Karachi, Pak-Emirates Military Hospital Rawalpindi and CMH Lahore, from 2005-2020.   Methodology: A total of 1530 consecutive chorionic villus samplings (CVS) were performed on pregnant females between 10-20 weeks of gestation using the transabdominal approach. Patients were subjected to integrated, stepwise sequential screening. Analysis of data was based on demographic features, indications for sampling, gestational age, attempts of CVS, needle aspiration time, assessment, placental location, sample yield, complications, pain estimation by visual analogue scale (VAS), CVS culture results and pregnancy outcomes. RESULTS: The most common indication for CVS was couple having thalassemia traits and history of having a thalassemia major child previously (55.2%). Pain was the most common complication (64.1%). Procedure-related pregnancy loss (considered to be till 20 weeks of gestation) was observed in two cases (0.1%) only. The most common abnormal karyotype was found to be ß-Thalassemia trait (23.6%) followed by ß-Thalassemia major (22.1%) and Trisomy 21(16.8%). No abnormality was detected in 33.5% of the cases. Five hundred and eighty-nine (38.4%) interruptions of pregnancies were done on the basis of CVS results. CONCLUSION: CVS is a safe and useful technique for sampling in prenatal diagnosis of genetic disorders, markedly affecting the management. KEY WORDS: Chorionic villus sampling, Pre-natal diagnosis, Karyotype.

Patient Safety Awareness Among Dental Students In Lahore, Pakistan: A Multi-Centre Studye.

BACKGROUND: Awareness of key issues associated with patient safety is vital for improving patient care in all fields of medical sciences including dentistry. This study was done to assess awareness among dental undergraduates towards patient safety in different dental institutions of Lahore, Pakistan. METHODS: It was a cross-sectional analytical study conducted at Combined Military Hospital Lahore Medical College & Institute of Dentistry from 1st May to 30th November, 2020. Two hundred third and fourth year BDS students (149 females and 51males; mean age 21.91±1.08) of 4 dental institutions of Lahore, mostly from private institutions (79.5%) completed Awareness of Patient Safety Questionnaire (APSQIII) to assess awareness of patient safety in dental undergraduates. Data was analyzed through SPSS 21. RESULTS: Teaching and learning about patient safety got the highest item scores while "Team functioning" got the highest 6.1 mean domain score. "Professional incompetence as an error cause" got the lowest 3.1 mean score followed by "Disclosure responsibility" (4.3). No significant difference was seen with respect to gender. Fourth year students were found to be more aware about error disclosure and error reporting confidence with statistically significant difference. All reverse coded items were scored in disagreed range by participants. CONCLUSIONS: Despite positive attitudes towards patient safety, lack of awareness was seen in key issues. Incorporation of patient safety in undergraduate curriculum may help in improving patient care and health services.

Society of Obstetricians and Gynecologists Pakistan Guideline on Second Trimester Anomaly Scan Published in year 2022.

The Guideline on Second trimester anomaly scan has been prepared by the National Maternal Fetal Medicine guidelines committee, approved by the Society of Obstetricians and Gynecologists Pakistan. These guidelines are developed in 2022 and will be reviewed after two years. The current document provides guidance about the importance of second trimester scan to practicing clinicians and sonologists. It will enable them to offer it timely offer to their patient this scan and refer them to the Fetal medicine specialist when indicated. It is unique as the document is modified according to local needs. The Guidelines are developed in 2022 and will be reviewed after two years.

Perceptions Of Medical Students About The Educational Environment At The Start And End Of Obstetrics And Gynaecology Rotation And Its Impact On Career Choice.

BACKGROUND: The educational environment can influence students' learning and their attitudes towards various medical specialties, thus affecting their career choices. This study aimed to compare perceptions of medical students about educational environment at the start and end of Obstetrics and Gynaecology (O&G) rotation and to assess if these perceptions influenced their career choices. METHODS: This was a Comparative analytical study carried out in the Obstetrics and Gynaecology Department, Combined Military Hospital Lahore Medical College from 1st February to 30th July 2019. Eighty-eight final year MBBS students (60 females and 28 males; average age 22±1.2 years) completed validated Dundee Ready Education Environment Measure (DREEM) questionnaire at the start and end of three weeks of O&G clinical rotation. Two questions were added post rotation to assess impact of their perceptions on career choice. Data was analysed through SPSS version 21 using independent sample t-test. RESULTS: Mean total DREEM score was 126.68±14.17 and 127.49±15.31 out of a maximum of 200 pre and post rotation (p-value 0.001). The sub-scale which improved significantly (p-value 0.010) was Perception of Environment with average scores of 27.88±4.63 and 28.25±4.64 pre and post rotation. Majority of female students (78.7%) felt motivated for choosing O&G as a career after this rotation. CONCLUSION: Final-year medical students perceived the learning environment to be positive. Clinical rotation helped in improving their perception about O&G learning environment and helped female students get more inclined to choose this specialty as a career.

Neural tube defects, their implications and solutions in Muslim society.

Neural Tube Defects (NTDs) are serious congenital abnormalities and most of them are incompatible with life. The extremely debilitating quality of life, if one survives, calls for actions to prevent such sufferings. Experts agree on the role of Folic Acid in primary prevention of NTDs, yet, despite best efforts, the use of Folic Acid has reduced NTDs by only 50%. These cases too can be prevented by employing secondary preventive measures. These involve timely interruption of pregnancy -- a decision which, in addition to a medical judgment, is based on ethics, social, cultural and Muslim religious value systems in Pakistan. Indeed, it is a complex issue but empathic understanding and strong co-ordination, once established between different disciplines, can help parents to decide and opt for necessary secondary prevention by interruption of malformed foetus within the given time frame mandated by medical and religious authorities.

Effect of oxytocin infusion on reducing blood loss during abdominal myomectomy: A randomized controlled trial.

OBJECTIVE: To assess oxytocin infusion efficacy in terms of mean blood loss in patients undergoing abdominal myomectomy. METHODS: The single-blind randomised control trial was conducted at the Obstetrics and Gynaecology Department of Military Hospital, Rawalpindi, Pakistan, July 15, 2017, to January 15, 2018, and comprised women with intramural fibroids of American Society of Anaesthesia class I and II who were candidates for elective abdominal myomectomy. The women were randomised into study and control groups. In the study group, an infusion of 30 units of oxytocin in 1000ml normal saline was given at the rate of 15 units/hour during surgery. In the control group, pure normal saline was given. The main outcome measure was intra-operative blood loss. Data was analysed using SPSS 21. RESULTS: Of the 60 women, there were 30(50%) in the study group with a mean age of 37.10±4.35 years, and 30(50%) in the control group with a mean age of 36.67±3.70 (p>0.05). Mean intra-operative blood loss in the study group was 409.67±181.29ml which was significantly lower than the control group 875.33±284.71 (p<0.05). The mean surgery time also showed statistically significant difference between the two groups (p<0.05). In the study group, 3(10%) patients required blood transfusion, while blood was transfused to 11(36.6%) patients in the control group (p=0.046). CONCLUSIONS: Oxytocin, when given as an infusion, was found to be effective in reducing blood loss during abdominal myomectomy.

An Audit of Caesarean Section Rate Using Modified Robson Criteria at a Tertiary Care Hospital.

OBJECTIVE: To evaluate the rising rate of caesarean section (CS) and its contributing factors at a tertiary care hospital. STUDY DESIGN: Clinical audit. PLACE AND DURATION OF STUDY: Obstetrics and Gynecology Department, Pak Emirates Military Hospital (PEMH), Rawalpindi, from January to December 2017. METHODOLOGY: All caesarean sections were classified according to modified Robson criteria into twelve groups, after modification. The size of each group, rate of caesarean section and contribution of each group was calculated. A re-audit was carried out after 6 months under the same protocol thus completing the audit cycle. RESULTS: CS rate was 54% (n=3878). The maximum contribution 27.42% (n=1976) to total CS rate was made by Group 5, 12.07% (n=870) by group 12 and 7.34% (n=531) by group 2. Re-audit showed a reduced CS rate of 38.2% (n=1342) with contribution by Group 5 reduced to 16.05% (n=563), Group 12 to 7.47% (n=262) and Group 2 reduced to 5.7% (n=202), respectively. CONCLUSION: Modified Robson Criteria is an effective auditing tool which identifies the exact areas where efforts and strategies are required to reduce the overall CS rate.

Role of Corticosteroids in Reducing Respiratory Morbidity in Neonates Delivered by Elective Cesarean Section before 39 Weeks.

OBJECTIVE: To determine the effect of dexamethasone administration to women between 37 to 39 weeks of gestation on neonatal outcome in terms of respiratory morbidity and the need for NICU admission. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Department of Neonatology, Military Hospital, Rawalpindi, Pakistan, from February to July 2017. METHODOLOGY: Women with singleton pregnancies, undergoing elective cesarean section between 37-39 weeks. Neonates were evaluated for any respiratory morbidity and need for NICU admission as well as need of mechanical ventilation, length of hospital stay and final outcome. RESULTS: Out of 535 patients, 240 (44.8%) patients received steroid cover before their elective cesarean section (group 1). Two hundred and ninety-five (55.2%) patients who did not receive steroid cover, were allocated group 2. Mean age of mothers in group 1 was 29.20 +4.50 years and in group 2, it was 29.34 +4.50 years. The mean gestational ages were 37.56 +0.66 weeks and 38.11 +0.79 weeks in groups 1 and 2, respectively. In group 2, 14 (4.74%) newborns developed transient tachypnea of newborn (TTN), which was higher than the newborns in group 1 (04 (1.66%), p = 0.049). Also the number of neonates being admitted to NICU was greater in group 2 than in group 1 [23 (7.79%) vs. 06 (2.5%) respectively, p = 0.007].However, there was no statistically significant difference between the two groups with regard to final outcome, requirement for mechanical ventilation, length of hospital stay and APGAR scores at one and five minutes. CONCLUSION: Steroid cover significantly reduced the risk of respiratory morbidity in babies delivered by elective cesarean section between 37-39 weeks.